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Beneficiaries Assignments

Foley & Lardner LLP

Two Recent Examples of Challenges To Collect “Reasonable” Charges

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Two recent cases illustrate the continuing challenges providers, and in particular hospital providers, face when seeking to collect their charges when dealing with “out-of-network” patients....more

Proskauer - Employee Benefits & Executive...

Ninth Circuit: Medical Providers Lack ERISA Standing

The Ninth Circuit affirmed two district court decisions that concluded medical providers were not “beneficiaries” under Section 502(a) of ERISA and therefore lacked standing to bring an ERISA claim...more

Foley & Lardner LLP

Beneficiary Assignment in the Proposed Revised Medicare Shared Savings Program Regulations

Foley & Lardner LLP on

This post addresses the changes that the rule would make to how CMS assigns beneficiaries to an ACO participating in the MSSP. The Proposed Rule places a renewed emphasis on primary care for beneficiary assignment. Section...more

Littler

Ninth Circuit Rules Assignee Health Care Providers May Sue Health Plans Under ERISA for Payment of Benefits

Littler on

In an opinion with mixed implications for both insurers and health care providers, the U.S. Court of Appeals for the Ninth Circuit recently ruled that when plan beneficiaries assign their claims for payment of benefits to...more

Proskauer - Employee Benefits & Executive...

Valid Assignment Confers Beneficiary Status on Chiropractor

A federal district court in Illinois recently issued a pair of rulings in cases where insurers sought to recoup payments from practitioners. Pennsylvania Chiropractic Association v. Blue Cross Blue Shield Association, 2013...more

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